iv ketamine with very high dissociation levels

Had to pause my treatment for 17 days cos of surgery/ a hospital stay.

At today's treatment, I found out my insurance is paying $2,500 per treatment session...

The development of the Ketamine nasal spray was so expensive that the dose I'm on costs $2,400.

(I.V. Ketamine is far cheaper, but according to my Dr is also less efficacious...?)

The hospital only charges my insurance $100 per treatment, even tho they put in alot of work re monitoring etc.

I don't know how I feel about that... 🙈
 
Thank you for these posts. I have been thinking about ketamine for a long time and now that I know what is wrong with me I am thinking about it even more. I knew a psychiatrist back in the early 90s who along with his psychiatrist father did a study on hard core alcoholics using ketamine. These were the worst of the worst, total gutter drunks in very advanced states of hopelessness. All participants were given conventional treatment and half the group was given ketamine therapy too. After one year the conventional group had 10% sobriety (about average for conventional treatment) and the ketamine group had 90% sobriety. There are lots of theories on why it worked so well, many think it is a William James type spiritual experience. Or it could be an awaking to the beauty in the world. Or maybe it is simply a realization on some level that they don’t have to be like that going forward. Whatever it is the numbers show it works. Thanks again.
 
So, today was my last planned "weekly" session, with the plan being to switch to fortnightly from now.

I do definitely feel like I'm "graduating" the first stage of treatment successfully... There's also this feeling of vague panic that this next phase might not work and that the massive depression symptoms may return or that the Ketamine may stop working...

Spoke to the Dr and the nurse about it today and they were great, as usual. We all agreed that we genuniely think that I'm "ready" to try this and that if it doesn't work that it's 100% fine for me to say so and to go back to weekly, if that's what's needed.

I'm sort of excited and sort of scared... Also feeling relieved about not having the complications of weekly sessions anymore... It's a lot of stuff to organise each time, cos I'm not allowed to drive and can't do anything else that day, etc etc. So going down to twice a month really frees up my schedule significantly. I mean, I've been investing the time and effort into the treatment days very gladly and gratefully, but it still has been a strain and exhausting at times, to get it to work in terms of scheduling etc.

Trying to trust my instinct, trust the Dr and the nurse, trust my body... and to focus on the graduation aspect and that it feels like a miracle that I've successfully completed the first phase of the treatment.
 
I found out my insurance is paying $2,500 per treatment session...
I don't know how I feel about that... 🙈
Oh and I followed up about this...

After 3 or 4 days of feeling really... guilty? about this... Feeling like I was costing my health insurance too much money, that I shouldn't be taking up this much "space", that it meant the pressure for treatment to be successful was really high...

I had an epiphany and decided to ask the Dr what a run-of-the-mill standard inpatient psych treatment costs per week at this clinic and the answer was $380 per day which is $2,600 per week.

So... given that I find each treatment session about as helpful as a MONTH'S worth of inpatient treatment, I figure I'm costing my health insurance only 25% of what I would be costing them doing all this treatment as normal inpatient treatment...

So that made me feel less guilty/ crap about it...
 
So, today was my first planned "fortnightly" session, after the initial phase of bi-weekly and then weekly treatments.

Getting through the 14 days was less fraught than I expected.

However... with today's being approximately the 20th (?) session... It was the first one that I would describe as a "negative" experience.

All the other ones have been filled with lots of positive feelings.

Today's session was weird... It felt weird, right from the very first moments... I remember thinking "Something's wrong with this batch of Ketamine" (because it was a new box from the pharmacy)... And it stayed that way for the whole session... Weird, uncomfortable, sort of anxious, trying to "ride it out" and waiting for it to be over...

About 10? or 15? minutes into it, I ended up pressing the "buzzer" for the nurse... And just told her that I wasn't having a very comfortable experience this time and whether she could check my blood pressure and pulse because due to the wooziness and fuzziness, I couldn't work out whether I was feeling crap "just" because it was negative emotions coming up... or whether there was some physical issue causing anxiety and distress... Literally couldn't tell one from the other in that state... I guess the way that sometimes people literally can't tell whether they're experiencing a panic attack or a heart attack... The effects of the Ketamine totally blurred that body/ brain divide and I couldn't tell one from the other...

The nurse seemed to think that my vital signs were fine and so that it didn't seem to be physical and tried to reassure me and told me to try and relax as best as I could... Which I did try to...

I was very grateful to have a) a buzzer, b) trained medical staff on hand, c) to be hooked up to a monitor measuring my vital signs, d) staff experienced and well-versed with the procedure so they know what to expect and how to deal with it...

I can definitely see how getting anxious during a session (or "trip") would lead to what people call a "bad trip"...

If negative/ distressing feelings arise, then it's easy to get scared/ panicky... And because you're totally incapacitated and disoriented and you can't tell what's coming from your body and what's coming from your brain... And because your sense of time is soooo skewed (a minute can feel like an hour) I can see how you could start feeling trapped and panicked inside the "trip" and if there's no kind, trained staff to reassure you and you're in it on your own or just have some stoned friends around... Then you could spiral into an intense panic attack *inside* the trip and it could be quite a harrowing experience...

Thankfully, I was spared that kind of escalation of the distress by the excellent safeguards described above. So, after some initial concern, I realised it was "just" negative emotions coming up but that everything else about the treatment session was "normal" and that it would be over before too long... I kept my eyes open this time, looking at the room to have a better sense of orientation and time and to be more grounded in reality... And it was kind of like waiting for an unpleasant dentist's appointment to be over... Not harrowing, but still "unpleasant".

Thankfully, both the nurse and the Dr were really great about it. Neither freaked out, both were really calm and supportive. After each session there's a 5 - 10 minute talk with the doctor, to discuss whether everything was okay, what effects were present during the treatment, how it's been impacting my depression between treatments, etc.

This time we naturally talked about the session feeling "negative" this time... And we both agreed that with the 3 hospital stays and surgery and an infected wound and a lung embolism where I came close to dying and had felt quite a bit of panic during the worst 48 hours of it... That those factors make it quite "natural" that my brain would have some negative emotions to process and that "my body feeling weird" would set off anxiety... So we've all agreed that a) it wasn't a big deal, b) it sort of was to be expected, c) that the staff dealt with it really well, d) that I'm not upset by the experience, e) it's normal for a small percentage of Ketamine treatment sessions to feel "negative" and f) to just wait and see how the next session goes...

While I very, very much hope that the next sessions will go back to feeling "good" again, it was also interesting to be exposed to my "negative" emotions and to be able to observe them (without it spiralling into a bad trip). I can't quite put it into words... It sort of felt like "facing my fears" in a good way... Sort of like doing exposure therapy and feeling stronger for having faced your fears, if that makes sense... Only that I sort of only half-faced them, I guess... Cos I literally did end up being scared that my body was malfunctioning again... So I was sort of half "in" the fear and only half facing/ observing it... But even that felt helpful in some way... Like it's part of a growth opportunity, or something like that....
 
So I had my next ketamine treatment yesterday... The first one since the "bad trip" experience...

We talked about the negative experience (the last session) at length, so that the Dr and nurses understood exactly how it had felt/ what had happened and we brainstormed ideas together of what steps to take to try and prevent it happening again/ how best to respond in case it did happen again. We put in tons of safety net measures and I felt comfortable and safe going into it, and only mildly apprehensive about it maybe happening again.

Glad to report tho, that it was 100% good, like all the other times, except for that last session... Was very relieved... Not so much because I was so worried about the negative experience itself... Given I had such excellent support and a safe setting, it was just "unpleasant" and not majorly distressing...

My main worry whenever there's a blip of any kind with this treatment is "OMG the ketamine treatment is not working anymore.... Nooooooooo....!!!"

Given that it's the only thing that's helped at all with this depression, it feels like it's my only tangible lifeline and I'm so aware of my desperation for this treatment to work and how my brain panics, whenever there's any reason to think that it might stop working...

Given that the healing its providing feels "magical" to me and like I'm a passive recipient in the treatment, it also feels like there's basically "nothing" I could "do" if it were to stop working.

I don't think that's techinically true tho... There's a ton of stuff I'm doing in terms of being compliant with the treatment protocols and I'm doing everything that I can to make it work as well as it possibly can...

But still, there's a sense of powerlessness that if it were to actually "stop working" then all my efforts would be irrelevant and I might be back to square one... So yeah, pretty panicky whenever there's a glitch of any kind cos I'm so desperate for this to keep helping.

As always, I went into yesterday's session with a spiritual/philosophical question regarding my depression... Given I knew that I might experience the anxiety/ fear of a "bad trip" again, I decided to go into it with an open mind and to "explore" the feeling of fear, if it arose... During the "trip" there was quite an intesne part, where I was shown that I am separate from my PTSD... Which is hard for me to see normally, because it started so early in childhood that I can't really remember what I was like "without PTSD" at all... So, being shown that so clearly was very interesting and helpful... Being shown that there is a "core" me, and that the PTSD is something external that happened to me and that it was a random thing that happened and does not define my identity and who I am...
 
Ugh... I've been trying to avoid thinking about this... but... I think my depression symptoms are getting worse again, since we went to fortnightly instead of weekly.

I think I'm trying to be in denial about this, because the weekly appointments are such a big burden, in terms of getting everything organised for it. It's such a massive headache and I was so relieved to be going to fortnightly. Especially because everything's been a hundred times more difficult since my surgery and embolism. Plus, I was sort of worried my health insurance might get antsy about the cost of the weekly sessions.

So, I think I made the decision to go weekly for other reasons than "what is best for my depression from a medical point of view".

I think I was hoping that I'd be able to "get away" with going fortnightly.

So far, I've just been trying to white knuckle through the uptick in depression symptoms because I really don't want to go back to weekly sessions.

But I think my brain is going into ever darker places again... Ugh...

My next appointment is in 11 days. I guess I'll have to tell the Dr, if things don't miraculously improve by then...

I would so much rather just stay in denial about it, tho.
 

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